PMS and Mental Health with Dr. Christine Hutchison

In this episode of the Relational Psych Podcast, hosted by Dr. Carly Claney, guest Dr. Christine Hutchison delves into the intricate relationship between PMS (Premenstrual Syndrome) and mental health. Dr. Hutchison, a clinical psychologist, explores the emotional and physical aspects of PMS, discussing its impact on women's lives from a psychodynamic perspective. The conversation includes insights from her research and clinical experience, examining how societal views and personal experiences shape the understanding and handling of PMS. The discussion also touches upon the broader implications of PMS on personal identity and relationships, offering a deep dive into this often misunderstood and stigmatized topic.

Links: 

1. Transforming Ghosts Into Ancestors: The Psychological Case for Reparations to Descendants of American Slavery: https://www.nwaps.org/events/reparations-event
2. Northwest Alliance for Psychoanalytic Study (NWAPS): https://nwaps.org/

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Transcript

PMS and Mental Health with Dr. Christine Hutchison
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[00:00:00] 

Carly Claney: If you want to learn about psychological growth without getting lost in complicated language, you're in the right place. This is the relational psych podcast. I'm your host, Dr. Carly Claney. Licensed psychologist and the founder and CEO of relational psych. On this show, we learn about the processes and theories behind personal growth. Please keep in mind that this podcast isn't a substitute for therapeutic advice, but we're here to point you in the right direction.

Well, today my guest is Dr. Christine Hutchison. Christine is a clinical psychologist in private practice in North Seattle, and she works with adults, couples, and teens from a relational, feminist, and psychodynamic therapy framework. She earned her doctorate in clinical psychology from the Wright Institute in Berkeley, California, and she currently serves as the president [00:01:00] elect of a large professional organization, Psychoanalytic Study.

Carly Claney: Christine, 

Christine Hutchison: thanks for joining me. Hi, Carly. Thanks for having me. 

Carly Claney: Absolutely. Our topic today is how do therapists address PMS? So there's a lot to say about that. And as we get started, what is PMS? Where do we even start? 

Christine Hutchison: Yeah, great question. PMS is A topic of the category of premenstrual distress.

That was actually the phrase I used in my dissertation research, which was on this topic. So premenstrual distress is a large umbrella category that is people who have menstrual cycles, who menstruate every month. Some of them report distress, emotional distress or physical distress in the week before menstruation.

So usually about starting up to five days before and they resolve within two days. 

Carly Claney: Yeah, so I think colloquially a lot of people would think about, oh, [00:02:00] you get really crabby before your period. You're very emotional. Moody. 

Christine Hutchison: And you might also have, you know, sore breasts or feel bloated or crampy.

Those are also the physical components of PMS, premenstrual distress. 

Carly Claney: Yeah. Yeah. I'm excited to talk more about it. Cause I, again, I think in society it's thrown around a lot as a sometimes. joke or sometimes something to really hold women in a particular way. And yeah, I'd love to just dive into it.

Oh, what is, what's your, what was your interest in this? Why did you start thinking about PMS and PMDD? 

Christine Hutchison: Yeah. Well, you kind of just named it that I so when I went back to school to get my doctorate and I was thinking about my dissertation topic, I had been practicing as a therapist for a few years at that point, and I worked mostly with cisgender women.

That's just who came into my practice. If any of your listeners are unfamiliar with that term, cisgender is just a person that identifies as the sex or gender that was assigned to them [00:03:00] at birth. So women who you know, were born and assigned as female and they tend to menstruate, although not all of them.

There can be many reasons why a cisgender woman wouldn't menstruate. But that was the bulk of my clientele, and I kept noticing this pattern that a lot of them would bring up PMS, they'd kind of name it, and it was often in this jokey or dismissive or apologetic way. So it was like, ever present for some people, and for some people it was, you know, rhythmically every month they would come up, but it didn't ever seem to occur to anybody as a topic that's really worth exploring.

It just was sort of, often just mentioned offhandedly, or often after the fact oh, well, I'm feeling better this week because last week. I had pretty bad PMS, you know, and my boyfriend really took the, you know, brunt of my anger anyway, moving right along. So I just kept noticing that, and as a psychodynamic therapist, and I know that's what relational psych specializes in as well, so psychodynamic therapy is a [00:04:00] little more interested in root causes of things deeper meanings of our experiences kind of.

Yeah you guys did an excellent podcast on defining psychodynamic therapy a year or so ago, so let's go back to that. But I was really interested in, you know, I want to talk about things deeper. I want to know, you know, how are your relationships impacting this? How is your idea of femininity impacting this?

How is your sense of self? What was your relationship with your mother? Did your mother talk about her menstrual cycle? Like I was so interested in this and people would kind of look at me like, we don't need to talk about that. Like you're not a doctor, you're a therapist. So moving right along. 

Carly Claney: So there was some differentiating.

They didn't think that was a space. Therapy would be a space to talk about PMS or their periods. And a lot of 

Christine Hutchison: people really welcomed it when they saw that I was interested in it. Like they were very excited to think about it and talk about it, but it's not something that seemed to have occurred to them.

And this was, by the way, you know, 2017. So a few years ago and the cultures changed a lot since then. So I think there might be a difference now. And as I was [00:05:00] thinking about, you know, I was listening to women talk about this and I was realizing at that point I had gone back to school. So I had been in graduate school for going on six years.

I could not recall a time where a menstrual cycle was like identified as something that might influence. human psychology including in human sexuality classes, it was not mentioned. And so it just felt like this is this giant obvious elephant, red elephant in the room that we need to start talking about.

So that was the beginning of my interest in writing about it and researching it. Yeah, 

Carly Claney: I love when the clinical work can inform our interest then. I know that might sound obvious, but the more it sounds like you are hearing women talk about it again and again, but very surfacy as you're like touching it, but not knowing that they could go into it.

And then your education so far hadn't told you how to think about it more 

Christine Hutchison: than that. Exactly. Yeah, exactly. 

Carly Claney: Yeah. So then what happened? How what came from your research or what did you dive into? 

Christine Hutchison: Yeah. I found an [00:06:00] advisor in my program that was also really excited about that topic. So I started my just initial looking and, you know, I wasn't looking in the medical research of PMS because I was in a psychology program.

So I was looking in just like what has been studied. And this was coincidentally around the time where a new diagnosis was added to our manual. The DSM, that diagnosis, the shorthand is PMDD, premenstrual dysphoric disorder. So this was just kind of burgeoning as a hot topic oh, we've got a new diagnosis approved.

So Okay, how do we treat this diagnosis? Is this a, you know, an actual psychological condition? What's the treatments? And as I started researching the research I found first that was most prolific was sort of shorter term cognitive behavioral type treatments. Which makes a lot of sense because those models of therapy are much shorter, so they're just easier to study, you get a group of people who say, I have really bad PMS, you work with them, you give them 12 sessions of cognitive behavioral therapy, or maybe a mindfulness [00:07:00] based therapy, I saw a lot of that, you have a control group, and then you measure the results so that's mostly what I found, and that had, you know, that research had really started to come out with the, new diagnosis that had been added.

But I was really having trouble finding anything written about, you know, how women or, you know, so I will just add a caveat. I think I said this, but my dissertation was focused on cisgender women who menstruate because that's the largest population of menstruating humans. So questions of how women were making meaning of their PMS, how they talked, how they thought about their menstrual cycle, how they talked to their partners or friends about the menstrual cycle any experiences from their life that may influence their experience of PMS.

I was not finding a whole lot about that. So that's when I decided that I really wanted to. Start the research on this. How are the more psychodynamically oriented therapists thinking about PMS talking to their women patients about PMS? I did find when I Did find a more psychoanalytic reference to PMS.

It [00:08:00] was you know in keeping with our intellectual lineage. It was very male centered. It was about, you know, it was a confirmation of penis envy, that it's, you know, women, girls must be thinking of this as proof of their caspiration. They don't have a penis, so they bleed. It's just part of this, you know, terrible thing that we're not men.

So that just felt you know, 60 years old. So I really wanted to find out, you know, in the year 2018, what are therapists, you know, saying and thinking about this? 

Carly Claney: Yeah. So it sounds like the meaning making about it, all of the other connections, all of those are things we're missing. And then the research, the more CBT or behavioral oriented research, was that mostly about like symptom based?

Like what did it? Yeah, 

Christine Hutchison: absolutely. You know, whenever there's a diagnosis that we sort of decided to add to our manual there's a number of Criteria that a person has to meet and they're always specified by like how severe and how long so in I don't have the book open, but the pmdd diagnosis you have to [00:09:00] have mood symptoms that interfere with relationships are functioning and they start up to five days before the period and they resolve at the beginning of the period.

So basically when you're conducting a research study, you're sending out a survey to a bunch of people saying, do you experience this? You know, mood swings, yes. Severe enough to impact your relationships, yes. Resolved within the second day. And then that's the thing you study. So it is very symptom based.

It's, there's no questions of how do you feel about being a woman? That's not going to be on that research study. It's just, can we help you, can we offer you some different ways of, communicating or thinking that alleviates some of these symptoms? That's what the studies were. 

Carly Claney: Yeah.

And so you wanted to know, not just how do we alleviate the symptoms, get rid of the distress, but what is happening in that experience? How does it interconnect to relationships and your identity, all these other 

Christine Hutchison: things? Yes, if we have a patient that reports some other really common experience, even if it [00:10:00] does have a little bit of a physical or biological connection, so if we have a patient that's getting stomach aches all the time, as therapists, we're, you know, of course we're interested go to the doctor, do you have GERD, you know, acid reflux, get some, get a workup.

Also, how's your anxiety? What kind of family were you raised in? What's your ACE score? You know, traumatic experiences you've had in your lives. So it's just really striking that we have this thing that has this huge emotional component and we're not asking those questions as therapists. 

Carly Claney: Sure.

Especially for something that affects nearly half the population. 

Christine Hutchison: Yeah. Huh. Exactly.

Carly Claney: So what would you like to dive into next? Would it be helpful to talk about the approach you took in the research or Oh, 

Christine Hutchison: no, that's boring. Let's, well, yeah, I'll talk briefly about that. So basically what I decided I wanted to do for my dissertation was interview psychoanalytic or psychodynamic therapists, because I wasn't finding anything that was already written.

So we need to kind of start from the ground up and, you know, rather than sending a survey to 300 therapists, it sounded way [00:11:00] more fun for me to talk to my friends. You know, I recruited. 11 therapists who were willing to sit down with me for an hour and just have me ask them, you know, what are you hearing from your cisgender women menstruating patients about PMS?

And how are you thinking about it? And how are you addressing it? So that'll just be a little teaser because we'll get into what those people said in a little bit. But actually where I went next in the research was looking into a couple of things that were fascinating. One is the kind of feminist.

psychologist, sociologist realm, how they were writing about PMS, and they had been writing about it for quite a few decades, unlike, you know, the clinical psychologists and also the correlation of PMS with past traumatic experiences. So I'll start with that last one, actually because this was a very striking thing to find.

Study after study showed a really strong correlation with the more severe someone's PMS, PMDD, premenstrual distress [00:12:00] is, the more likely they are to have experienced abuse in their upbringing, or other kinds of trauma, but specifically physical and sexual abuse. That in itself that's huge, right?

So let's say a 30 year old woman comes in and says, oh, ha, I have really bad PMS, I just rail into my boyfriend every month, and I take a day off work, and I cry all day. As therapists, we want to be thinking, oh, okay, abuse? Did she come from an abusive background? Does she have a really traumatic kind of early upbringing?

That's not just nothing that she is having severe PMS. And of course, the caveat is with anything that's a combination of medical and psychological, you have a whole spectrum . So I want to acknowledge there are people that have really difficult periods or really bad PMS mood symptoms that may or may not have that past experience of trauma, but the research was pretty consistent in showing that the correlation between those two are very strong. 

Carly Claney: Yeah, sure. And a note of [00:13:00] correlation does not equal causation. We hear that a lot in graduate school. And yet I think that doesn't dismiss the correlation, that there are these patterns of when you see it again and again.

And I was even struck by some of the wording you just said that I might've just forgotten. 

Christine Hutchison: It's not, 

Carly Claney: it's not nothing that it's so easy to just think, ha, this doesn't mean anything and yet it just seems so impactful when we're seeing this connection with abuse and how the body reacts to such a traumatic experience.

Christine Hutchison: Yes, exactly. Yeah. And you know, we're kind of, and this I think has been something the field has been interested in for a little over a decade now, the somatic experiencing of trauma. So this fits right in with that, right? 

Carly Claney: Yeah. Yeah. Was there anything else about trauma? Was other types of trauma or was it mainly abuse or sexual abuse in childhood?

If 

Christine Hutchison: I remember right, the strongest correlation was adolescent physical and sexual abuse. That was most [00:14:00] likely to be correlated with PMDD or severe PMS symptoms. Other types of trauma, you know, if you have a, you know, really horrible car accident, that's less likely to have a correlation with.

symptoms, but all kinds of trauma has some correlation with the strongest one being sexual or physical abuse in adolescence, specifically. 

Carly Claney: That's interesting. The timing of that is interesting, too, thinking about when people start 

Christine Hutchison: menstruating. Exactly. Yeah. And with the the beginning of menstruation often being a beginning of Sexual experience too, not necessarily having sexual experiences with other people, but just feeling one's own desire, sexuality.

Carly Claney: Yeah. Yeah. What did the feminist theories say about it? Oh, 

Christine Hutchison: girl. Oh, girl. So much. Let's get into it. I'm going to take a quick moment because this part is a lot. So one of the first, so The feminist writing that I encountered, a lot of it was from the 90s and early 2000s, which interestingly I think that was a heyday for [00:15:00] feminist psychology, and I would like to get it back updated for.

But they were largely really critical of this idea of PMS. The first, Criticism that I read a lot was these writers would point out that we medicalize everything to do with women's health. We kind of want to ascribe a medical or biological reasoning for it, and it's often really pathologizing.

So I'm gonna read a quote from two I believe these are psychologists, Joan Kreisler and Paula Kaplan. In one of their articles they wrote, "Each time women make substantial gains in political, economic, or social power, Medical or scientific experts step forward to warn that women cannot go any further without risking damage to their delicate physical and mental health."

So you think of if they're writing in the late 90s, like the 90s, late 80s, 90s, when women kind of started really entering the political field not putting up with a lot of the traditional sexism in workplaces. [00:16:00] And so that's when they started writing about, you know, we're hearing a lot about this PMS business.

What is the function of this rhetoric? 

Carly Claney: So the critique comes to medicalizing it or to collecting these symptoms and this is now a female diagnosis 

Christine Hutchison: Yes, so they're not saying it's not real a lot of the international research interestingly shows that women in non western cultures, they do experience premenstrual changes.

So they'll be like, Oh yeah, my boobs get sore. Yeah, I totally, you know, I do bloat a little bit. Yeah, periods coming, but it's not always this emotionally loaded Oh, and I blow up at my partner and I'm so angry. So they were questioning that if it's not like we don't have menstrual cycles and there's not a change, but what is this weight, this pathology described to it, that it needs to be a syndrome.

that it's a narrative we put forth that has to do with a time when women are more quote unquote volatile or delicate related to this. I [00:17:00] read a couple articles that discussed PMS, they called it a culture bound syndrome. So a culture bound syndrome is. It's a collection of experiences or diagnoses or phenomena that it's not that they're quote unquote made up or not real, but it's that they seem to exist inside particular cultures and not necessarily in other cultures.

So something like, Okay, this is not my expertise, but psychosis is not really a culture bound symptom. I think we make different meaning of it throughout culture, but that's a phenomenon that exists in individuals throughout cultures. But these feminist sociologists and psychologists were saying, it seems like the West is real obsessed with this idea of PMS, so how do we both honor that this is the experience women have?

They are honestly. They're not making this up. They're not drinking the Kool Aid, nothing like that, but there is something about Western culture and maybe our our particular brand of misogyny that seems to be creating this cluster [00:18:00] of experiences. 

Carly Claney: That's such an interesting tension you just pointed out of again, honoring the experiences of saying there is something here that's distressing collectively in this group.

And yet, pointing it out, it seems like it's How do I say it? Like it, it is over emphasizing something or it's pathologizing something that maybe isn't, doesn't need to be pathologized. 

Christine Hutchison: I remember in one of the articles, I can't remember which one, but somebody pointed out we talk about bloating, you know, I bloat and that has so much to do with fat phobia.

And also, I don't know if y'all remember like the early 2010s, skinny jeans. like tight, like we wear tight clothing. And so they pointed out there are cultures where you're walking around say in a sari, you don't really know this if you're bloated. And if you do, it's not this, Oh my gosh, my femininity is threatened.

I'm not desirable. Of course that makes you feel like crap. Right. If that's the meaning, right. So there are other places where the physical [00:19:00] experiences are still there, but they're not, the meaning is different. 

Carly Claney: Yeah. As you said, it's not a threat to your femininity. It doesn't hit in your identity or your worth or anything else that becomes so much bigger than what, again, that, that discrete symptom could be.

Christine Hutchison: Yeah, exactly. Exactly. So if anybody is like already hooked and they're like, Oh my God, I want to read some of these things. My favorite article that I read as part of my research. It's 30 years old at this point. If anybody of your listeners is really interested in this topic and you're like, I already want to read everything that this lady's talking about, my favorite article that I read as part of my research, it was by an Australian researcher, Dr. Jean Ussher. And she wrote an article called Dr. Jekyll and Mrs. Hyde. And this article is 20 or 30 years old at this point, but I think it still stands up. So she wrote about the kind of experiences that women report of irritability and anger [00:20:00] premenstrually. And she says that is experienced by a woman as a disruption in her ordinary pattern.

So her ordinary pattern of self silencing and self. policing. So what Dr. Usher is saying is we have this cultural mandate that women are nice, quiet self policing. So if I have an angry thought, boy the filter's got to be in place there. I'm not just gonna, not gonna be a, you know, b word and burst out with what I really want to say.

And often whatever happens hormonally, physically, in the premenstrual period, it makes that a little harder to do. And so women tend to blame their biology, rather than what's actually going on in their lives. And it results in this split sense of self, that I'm my regular self, three weeks of the year, I'm good, I'm quiet, I'm nice, I treat my partner well, I'm, you know, a good mom, whatever it is, and then one week a month, who is this? The monster comes out, right? Yeah. And it, [00:21:00] this narrative serves to discourage women from saying, Hey, what's going on in my life that, I'm not okay with. That's making me not able to feel good. And whether it's one week a month that I feel these things or three weeks a month or something, you know, that's not working.

Is it my relationships? Is it my job? Is it my culture? It's like we're kind of, discouraged from asking those questions. Yeah. 

Carly Claney: That's an interesting comparison that it could be on either end. Both the three weeks out of the month where all your defenses have access to be so high versus that one week where it seems like there could be more freedom to be how it actually is.

Feel what you're actually feeling rather than having this barrier push, push down upon 

Christine Hutchison: you. Yeah, and I want to just flag what you said about the three weeks of the month where your defenses are in working order because that was something, a little foreshadowing, that came up a lot in my interviewing there.

About this.

Carly Claney: Well, is there any [00:22:00] other research we should set a foundation for before we get to your findings? 

Christine Hutchison: Absolutely. Oh my gosh. So much. I have to cherry pick the best research. Back to this idea of medicalization. One thing I thought was really interesting is that the reason will not be reason, but one of the factors in getting this new diagnosis, PMDD added was, you know, of course, there's lobbying for everything and the company that makes Prozac, the short story is I They could extend their patent if they had another diagnosis that they could treat with their medication.

And Prozac is a very effective medication. I'm not knocking it. Great for depression. But this diagnosis of PMDD essentially allowed the patent to be extended. It's a question of whose interests were being served by getting this diagnosis and it's complicated. I'll acknowledge that.

But the Prozac lobby was hot on the case of wanting PMDD in the DSM they did originally [00:23:00] rebrand Prozac as a treatment for PMS and PMDD, and they initially named it Seraphem. That's S A R A F E M. I don't know if you're familiar with the, I don't know if it's a Greek or Latin term, Seraphim, as in angels.

Like in the old Renaissance painting, God is surrounded by cherubim and seraphim. They're literally angels. And then they spelled it with an F E M at the end, like the feminine. So they were, And it was literally a little, I don't remember if it was pink or purple, it was either a little pink or purple pill.

So they literally tried to make this medication to make women the quiet, nice, polite they really were working that. And I think it didn't pull well or something, so they didn't stick with that one, but that's another, that was another critique of kind of the Feminist researchers is, there's some agendas here that aren't necessarily in the best interest of women.

Carly Claney: Yeah, it seems like this is outside of our scope today, but the bringing in lobbying, bringing in capitalism, like all of those different things that play into what's actually happening from [00:24:00] the 

Christine Hutchison: perspective. And then the one more piece of research that I found. Really fascinating is there was a lot of correlation between premenstrual distress and the supportiveness or lack of support from one's intimate partner.

As you might imagine, people who had more understanding supportive partners tend to report less premenstrual distress and people who had partners who are impatient mocking, critical, jokey. Not understanding of PMS, often had more severe PMS symptoms. And in one really interesting Australian study lesbian women reported way more responsiveness to needs, open communication, and the sharing of responsibility from their partners around their menstrual cycles.

They reported a lot more like kind negotiating and I'm about to start my period I don't want to talk about this, [00:25:00] and they often, lesbian women, would have partners that would say, oh, totally, I get it, you know, let me know, how about I do the dishes tonight and then, you know, maybe the lesbian partner is going through the same thing two weeks from now, whereas women in partnerships with men reported a lot more premenstrual distress and also not surprisingly a lot more animosity from their partners around their PMS. And the good news is there was also another study from Iran of all places that the study was a pre and post study. So they surveyed women who were married to men on their partner's level of understanding about PMS. And then they provided an education session to the husbands. And then they did a post survey. And there was like this phenomenal change in almost all of the participants that the women just felt so much more kind of understood and a lot less distressed around the impact of their periods once their, you know, husbands kind of had a little more information.

Carly Claney: Wow. [00:26:00] There's videos out now of doing the simulation of cramps where the man in the relationship will be able to see it and ranking it and it sounds like what I think I'm hearing from that study is that the understanding when I'll just stick with the heterosexual relationship when the woman feels like the man, her partner understands what she's going through, that her distress around what she's experiencing is decreased.

Yeah. 

Christine Hutchison: Yes. And it makes so much sense, right? Even, you know, I have friends that have severe migraines, and they're like, when I have to like, justify and explain and defend and say I really am experiencing pain, it makes it so much worse, but when you have relationships where they're like, oh my gosh.

Totally understand that you need some flexibility here. I hope you feel better. It's just that's the way that's the way of all suffering. So it makes sense. Yeah. 

Carly Claney: Yeah. Wow. So yeah, I can really see that there's such a foundation now for different ways of thinking about PMS. different guesses or even findings already as [00:27:00] to like what increases or decreases the distress around it.

I'm curious, you, it sounds like you didn't interview actual patients with PMS, but rather their therapists. 

Christine Hutchison: What was that? Yeah, no fair question. I thought about both. I really did consider both, but I think because I myself as a therapist, I put myself Theoretically in the home of psychodynamic psychoanalytic therapy, and I was really irked that I wasn't offered training on this. I think that's where I felt myself feeling most itchy. I want to get some textbooks and training and I want this. Talked about in our coursework, and the kind of quickest way to participate in creating that was to work with interviewing therapists rather than patients.

But God, it would have been such a, you know, interesting study also to do interviews with women who. Have PMS and how they think about it. And you know, I would have loved that too. Yeah 

Carly Claney: in 20 years when you're ready to do some more 

Christine Hutchison: research. I have a lot of fantasy alternate [00:28:00] dissertations that I would have done if I had done it again.

Carly Claney: Yeah, but it sounds like even thinking back to the patients that you had that started this way of thinking I get the sense that they might not have had the language that these therapists that you interviewed would have, that the therapists were able to see patterns and already have, again, some of the language to make sense about what's happening.

Christine Hutchison: Absolutely. And interestingly, do you mind if I talk a little bit about what I found when I interviewed therapists? So one of the most common themes from these therapists was that they were experiencing the same thing that started my interest, which was, This is a really hard topic for people to stay with.

It's often brought up in a dismissive way. It's often never brought up. You know, a lot of the My interviewees said oh yeah, I have a lot of women in my practice and maybe one or two of them have mentioned their PMS but I think all of them have regular menstrual cycles and it's just one of every four weeks my patient is menstruating and we don't talk about it.

Wow, you know, oh, our cultural silencing around this really [00:29:00] is a thing. And it often put the therapists in this position of questioning, is it my job to bring it up? Because as. You know, more psychodynamic therapists, or a lot of other types of therapists, the value is in following the client's lead.

It's your space, client, you use therapy how you want, you bring up the things that's important to you. The therapist is not imposing an agenda on you. But the therapist I interviewed expressed this bind of But if this is something that is so meaningful and important and there's a mandate of silence around it that maybe the person doesn't even realize, you know, should I probe around in this?

Carly Claney: Create more space. Open something up that maybe the person wouldn't have thought to go more into. 

Christine Hutchison: Exactly. And it can be, you know, maybe it would even be perceived as an invitation. And I'm sure, you know, you experience this in your practice where sometimes you will kind of throw out a, you know, a little bone.[00:30:00] 

If we could talk about this and there can be such a reaction of relief, we can talk about this. Oh my God, I can talk about this? 

Carly Claney: Yeah, and that does, it feels very different than having this agenda of this is how we're going to talk about this, and you must think this particular way versus that 

Christine Hutchison: invitation.

Absolutely. And I think we feel this as therapists about a lot of things, should I follow their lead? Should I wait? Or should I probe? I know that's a question that it sounds, feels familiar to me to ask about that. Yeah, it does. So my interviewees none of them were surprised to hear that there was a strong correlation between premenstrual distress and trauma.

I think almost every single one of them, when I shared that I had found that in my research, they said, oh, that makes sense. Yeah, had I done the dissertation of interviewing women who experienced PMS, I wonder if that would have felt like a revelation or been surprising.

Carly Claney: Yeah. Again, that thinking about that permission or we haven't [00:31:00] really talked about what it the meaning making about it quite yet but are they, would they think differently about their experience of trauma? Would they think differently about their experience of PMS? If they could see this connection?

Christine Hutchison: Absolutely. I know it changed the way I think about both those things. You mentioned before, Carly, that this idea of we have our psychic defenses, we have the ways we emotionally protect ourselves and rationalize and keep bad feelings away, that maybe we have those intact for three weeks and for whatever reason, whether that's our kind of unconscious permission we give ourselves during PMS to feel all our feelings, or if there's some hormonal shift that makes it a little harder to have those defenses. That was something that came up in my interviews a lot. A lot of therapists sort of thought without, sometimes without even realizing this is how they were conceptualizing it.

They thought about PMS as, oh, that's the time when the defenses are down. And as a result of that, a lot of these therapists viewed PMS as a very valuable time in therapy. So whereas our culture kind of has this [00:32:00] message of, Ooh, ride it out. Don't think too hard. Don't say that thing to your partner. Don't, you know, just keep your mouth shut until therapists viewed it as come in.

Oh my God, I hope that our session is happening. having their premenstrual, you know, experience because what we want as therapists is to hear what's the thing that's a little bit underground for most of the month that actually really needs some watering and tending to. 

Carly Claney: Yeah.

Yeah. Again, that invitation of what is here that we hadn't we aren't able to get to when the defenses are keeping it back. And it seems like there's so much richness that came from those sessions. 

Christine Hutchison: Yes. Yes, absolutely. And I wonder if there's some correlation between the therapy sessions that people experience is very profound and breakthrough and premenstrual, the premenstrual week.

I wonder how often those correlate and we don't even realize that they're. Happening at the same time. 

Carly Claney: Yeah. Yeah. And I mean, now I'm just going from it, but like how many other rhythms happen? I think for women to, who are [00:33:00] menstruating, who go through such a cycle, like a monthly cycle, it's so striking that there's this built in rhythm.

But yeah, how many other things could be 

Christine Hutchison: connected to that? Yes, and what happens during ovulation, and there's probably a lot that's being drawn on, evoked unconsciously probed at different times in the cell. Yeah. One of the quotes from my participants around this that I loved, somebody said, If patriarchy tells women to dismiss themselves, then PMS is the thing that can break through that.

Mmm. So I just love that framing, that what a gift, and that's something a lot of my interviewees had said some version of "wow, this is really a gift. This could be a gift to somebody's relationship. Wow, if we really listen to women, then they can tell us the truth of what's happening in our relationships, what's happening in our families, what's happening in our communities."

Carly Claney: I get how scary that is when the fear is that will threaten then those relationships, the life that comes if people actually knew what I felt or what I [00:34:00] thought. And yet I like this reframing of no, but that's. That's the truth. That's how you actually feel. And then it's a gift to be able to actually be with it.

Christine Hutchison: Yes. And we know that other problems come from trying to deny the truth. And sometimes the truth causes what we might perceive, at least initially as a bigger problem, that it's not smooth sailing to try not to say the thing. And you know, this PMS can be seen as this real gift of "I'm going to tell the truth to myself and I'm going to figure out how to tell the truth to my community, my whoever." 

Carly Claney: Did that change at all how therapists thought of this new diagnosis then? Was there appreciation for having this collection of symptoms? 

Christine Hutchison: Great question.

I heard so much ambivalence from therapists about this new diagnosis. And therapists, I think, tend to be ambivalent about diagnosis in general. I don't know if this is something that's been addressed on your podcast, but for every person that says, "Oh, it's bipolar disorder [00:35:00] I have. Oh my God, thank God I didn't know what was going on. It was so scary." Sometimes it can be so validating. And then there's another person that says, " as soon as I learned I had bipolar, my partner didn't take me as seriously, and I can't get good mental health care", and it's very stigmatizing.

So we hear all ends of the spectrum. PMDD, premenstrual dysphoric disorder, was no different. My interviewees expressed that. It can be real relief to have a name, and for a population that tends to be frequently dismissed in the medical system, that would be women. Maybe it's a good thing to have something to point to, to say, hey, my suffering is really severe.

This needs, this isn't haha, oh yeah, you're just a woman. I need some help here. So that's the potential benefit of this diagnosis. And of course, you know, the drawbacks, and that's where a lot of the kind of feminist criticism came in was, are we actually just furthering the same problem, where we're pathologizing something that doesn't need to be pathologized?

Carly Claney: Yeah, [00:36:00] again, that tension just feels so real because I'm thinking historically about histrionic. You know, it's a personality disorder, but before how it was seen so many years ago and still the ripple effects of that. And yet what you're saying to the validation of you're not just. You're not just weak.

You're not just complaining. You're not just making a big deal out of nothing. Here's a statistic of, well, medically there is something that is statistically significant or impairing your functioning in these 

Christine Hutchison: different states. Exactly. Yep. Yep. Real double edged sword for sure. Yeah. Yeah. 

Carly Claney: Anything else?

What else did they say? 

Christine Hutchison: Well, I'll just say the last thing that I really stood out to me that I even years later, continue thinking about is one of the things we're interested therapists that tend to be more depth oriented or psychodynamic, especially psychodynamic. One of the things we really want to provide is to help somebody integrate different parts of themselves.

And so that, Sounds a little woo, that's a little fuzzy, but the idea [00:37:00] is if somebody has been through really difficult things or been through a lot of trauma, they might. I feel like different people in different contexts like, wow, I'm a really caring mother. But as soon as my partner forgets to X, Y, Z, I turn into this other person.

Our goal as therapists is to help people feel a little more consistent within themselves. And because Often PMS is experienced as a different, we call it a different self state. Oh, this isn't quote unquote really me. This is my PMS self Therapists were very interested in how do we use therapy in the therapy room to start to integrate Dr Jekyll and Mrs Hyde to start to just be whole people that have Different experiences at different times, but there's continuity among it.

So I'll just quote one of the therapists I interviewed So she said one of the things she might say to a client is Do you think it's possible that this thing you're upset about that you wouldn't be upset about on a non pms day? But this really is bothering you on a low grade level. You're [00:38:00] just staying unaware of that throughout the rest of the month.

So I'll leave that as an invitation. I'm aware you may have listeners that do have difficult periods, do experience PMS, and that can be something to start to think about if it's maybe not this kind that you just have to get through, but it can be something that is actually calling onto your awareness and inviting into a larger experience of yourself.

Carly Claney: Yeah. With that, I'm thinking again of what we talked about with the invitation, giving permission and not splitting off. That is a technical term, but meaning just like keeping something either wanting to like. Actually break something away from you, kill it off because I hate this part of me or this part is bad, or just wanting to ignore something that is so much a part of our experience.

It seems like this is an invitation to just bring it all in, see how it fits together. 

Christine Hutchison: And I hope this podcast may also be an invitation that therapists, we really want to [00:39:00] hear about it. We really want to hear about your experience. So you're not going to have a therapist that's going to be like, oh, you, oh, you menstruate.

Oh, you know, this is interesting. This is good stuff. So if you're therapist hasn't brought this up, you are welcome to and same for your listeners who are therapists. Because I did my research on this, it's been on my mind so much that I do bring it up more often and it's rich.

It usually, there's a, people have a lot of, even if they don't have a lot of distress, there's a lot of associations and meanings that people have about their periods. And there's a lot of research that didn't exist when I was doing this a few years ago, so I don't know it, but trans people's experience of menstruation when a menstrual cycle feels really counter to one's gender, that can be really difficult.

So please feel free to just drop a line and see see what gets. What gets pulled in from there? 

Carly Claney: Yeah, we didn't talk a lot about femininity or elements of gender identity, how it fits into. I don't think we'll really have time to really get into that, but I'm thinking of what you said, either trans [00:40:00] identity or women whose menstruation, maybe it's not complicated by PMDD, but there's other elements of not a, an Maybe there's not a consistent rhythm to it, or maybe taking birth control, certain elements of birth control changes the cycle, or different kinds of treatments, whatever might change it.

There's so many other things that really impact that, and I can see them getting connected to so many different parts of 

Christine Hutchison: identity. Yes. Yes, absolutely. And just so you don't get a bunch of emails I just want to acknowledge that there is a very real medical biological component. There's many kind of conditions that might make periods more severe that are treatable.

We did not talk about because we are not medical people. If you have really difficult periods, also feel free to seek health care for it too. Yeah, that's 

Carly Claney: a good thing. Can you say a little bit about that in terms of the diagnosis of PMDD, PMS? Like how if someone is sitting, you know, listening to this and really thinking, okay, is it something like endometriosis or is it like [00:41:00] what is happening here?

What could be a the first or second step to kind of start that journey? 

Christine Hutchison: Yeah, absolutely. You know, It's always good to go to the doctor for things, and part of us, I think, I know for myself as a therapist, I'm always very scared that I'm going to really get into the meaning and the story and the narrative and all of that and miss that there's just a biological thing happening that needs addressing.

Always feel free. Go to the doctor. Go to the doctor. Talk to your doctor. And the PMDD diagnosis, because it's in the Diagnostic Manual for Mental Disorders, it is really focused. The criteria are about emotional, relational parts of that. If you feel like my periods are what my doctor says is in the range of normal Or what feels fine, they feel tolerable to me, but emotionally I can really go to a dark place, or I can really feel like a different person then that's something that maybe therapy would be a little more able to address.

That if you're pretty sure the [00:42:00] physical component is within the range of, you know, quote unquote normal. Hate using that word, but yeah. 

Carly Claney: Yeah. Then that's a good point to, to even to know that there, there are normal curves. There is something that's normative and having the combined team of, this is my doctor.

Who's going to help me understand medically here or hormonally. And then the psychologist or therapist going to think with me on the emotional relational side, there's all different parts that can help. 

Christine Hutchison: Absolutely. Yep. 

Carly Claney: Well, thank you so much. I feel like we got a lot of information and we also just got a lot of stimulating thoughts around it that I'm going to be thinking about and I hope that we can just keep the conversation more 

Christine Hutchison: alive.

Yeah, thanks so much for having me on. It's really fun to, it's very fun to talk about this a few years after this was my world for a year or so. Yeah , it was really fun to get to review some of this literature and it's a lot of these criticisms, they're multiple decades old and they still feel so relevant as I am, myself, I'm a cisgender woman [00:43:00] in this world and I still read this and I'm like yes.

We're still being dismissed in this way I know the Barbie movie was. Great. But this is still what's going on. And so I'm really happy to get to talk about it and get to think through it with you. 

Carly Claney: Yeah. Thank you. If anyone wants to talk to you directly about it, I will leave your contact information in the show notes.

Anything else that you want to share a plug or talk about of getting connected? 

Christine Hutchison: Well, this is a great left turn, but you did mention at the beginning of my other role that I'm on the board of a professional organization, so this is for both the therapists who are your listeners and the not therapists who are your listeners.

We have a really cool event coming up and it's for professionals and the public in general. We're hosting event, an event on the psychological case for reparations. So we have two psychologists. That are flying up from California to talk about reparations for black Americans and specifically [00:44:00] the, what does it do to our psychology collectively?

people of all races to have slavery in our history? What does it do to us psychologically that we have not repaired for that? And what might it offer to us psychologically to have repair for that and to really think through restitution and repair for a legacy of slavery? And I'm just so excited about it.

We decided to make it open to the public because it is such an important topic. So that will be coming up in a few months on March. 30th in the morning. 

Carly Claney: That seems, I mean, such an important topic and it's really cool. Not a lot of events are open to the public in that way. And so that's a really neat opportunity . 

Christine Hutchison: Absolutely. And the website for. The Northwest Alliance is nwaps. org. So the information, I believe it's already up on the website, but it definitely will be by the time this podcast comes out.

Wonderful. 

Carly Claney: You there. Yeah. Thank you so much for sharing 

Christine Hutchison: with us. [00:45:00] Thank you, Carly. This was really fun.

Carly Claney: Relational Psych is a mental health group practice providing depth oriented psychotherapy and psychological testing in person in Seattle and online in Washington State.

If you're interested in mental health care for yourself or a family member, please reach out. Our website is relationalpsych. group.